International Differences in Multiple Sclerosis Health Outcomes and Associated Factors in a Cross-sectional Survey

Abstract

Multiple sclerosis (MS) is a major cause of disability and poor quality of life (QOL). Previous studies have shown differences in MS health outcomes between countries. This study aimed to examine the associations between international regions and health outcomes in people with MS. Self-reported data were taken from the Health Outcomes and Lifestyle In a Sample of people with Multiple Sclerosis online survey collected in 2012. The 2,401 participants from 37 countries were categorized into three regions: Australasia, Europe, and North America. Differences were observed between regions in disability, physical and mental health QOL, fatigue, and depression, but most of these disappeared after adjusting for sociodemographic, disease, and lifestyle factors in multivariable regression models. However, adjusted odds for disability were higher in Europe [odds ratio (OR): 2.17, 95% confidence interval (CI): 1.28 to 3.67] and North America (OR: 1.79, 95% CI: 1.28 to 2.51) compared to Australasia. There may be other unmeasured factors that vary between regions, including differences in access and quality of healthcare services, determining disability in MS. When assessing differences in MS health outcomes, lifestyle factors and medication use should be taken into consideration.

Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review

“…Physicians and/or researchers administered the assessment in four studies [ 17 , 19 , 43 , 44 ] and seven studies did not specify an administration method [ 45 – 51 ]. Most studies ( n = 25 studies) were conducted in Europe, North America, and Australasia [ 18 , 21 – 24 , 26 – 33 , 36 – 39 , 42 , 43 , 45 , 48 – 52 ] and an additional five records were linked to the same international study in which most of the participants reported living in North America, Australasia, and Europe [ 11 , 25 , 34 , 35 , 40 ]. The remaining five datasets were from South America, the Middle East, or the region was not reported [ 17 , 19 , 20 , 46 , 47 ].…”

“…The 12 studies that measured fatigue using a validated scale, did not restrict enrolment to CIS only, and did not restrict by level of disability may provide the most reliable and generalizable estimates of fatigue prevalence in the overall MS population. The prevalence of fatigue in these studies ranged from 36.5 to 78.0% [ 11 , 18 , 21 , 25 , 28 , 34 , 35 , 40 , 42 , 47 , 50 , 51 ]. Eight of these studies (describing nine datasets) recruited 300 or more participants, the number required to estimate fatigue prevalence in pwMS with a standard error of ≤5%, assuming that fatigue prevalence was 60%; these studies reported prevalence estimates ranging from 36.5 to 78.0% [ 11 , 25 , 34 , 35 , 40 , 42 , 48 , 50 ].…”

“…The prevalence of fatigue in these studies ranged from 36.5 to 78.0% [ 11 , 18 , 21 , 25 , 28 , 34 , 35 , 40 , 42 , 47 , 50 , 51 ]. Eight of these studies (describing nine datasets) recruited 300 or more participants, the number required to estimate fatigue prevalence in pwMS with a standard error of ≤5%, assuming that fatigue prevalence was 60%; these studies reported prevalence estimates ranging from 36.5 to 78.0% [ 11 , 25 , 34 , 35 , 40 , 42 , 48 , 50 ].…”

Fatigue is associated with physical inactivity in people with multiple sclerosis despite different environmental backgrounds: Merging and comparing cohorts from Turkey and Israel

“…They also observed that the distribution of physical activity levels varied between regions. Whereas, 29.9% of PwMS were classi ed at a high physical activity level in North America, only 22.2% were classi ed at that level in Europe [11].…”

“…Only sparse data exist relating to the physical activity participation of PwMS from different environmental backgrounds. Reily et al [11] examined the prevalence of various comorbidities and modi able lifestyle factors in PwMS, including the level of physical activity performed in different global regions (Australia, Europe, and North America). The authors found a strong inverse relationship between the level of physical inactivity and the physical aspects of quality of life in the total cohort.…”